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Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute. 

Botulinum toxin-A a potential treatment for painful joint disease

17 Aug 2017

Intra-articular injections of botulinum toxin-A (BT) deliver substantial short-term benefits in terms of pain reduction in patients with refractory joint pain, according to a meta-analysis.

Researchers searched multiple electronic databases, as well as grey literature, for studies evaluating the effect of BT intra-articular injections in the treatment of painful osteoarticular disease.

A total of six studies involving 382 patients were included in the meta-analysis, which was performed by comparing the numeric rating scale (NRS; from 0 to 10) at baseline and at 1 or 2 months and 6 months after treatment between the BT and control groups. A separate comparison was made between low- and high-dose BT at a follow-up of 1 or 2 months.

Of the five trials comparing NRS at 1 or 2 months regardless of the dose of BT, four reported that BT had a positive effect on the NRS compared with the control treatment, whereas the remaining study found no effect. The overall weighted mean difference was -1.10 (95 percent CI, -1.62 to -0.58; p<0.0001; I2=63 percent).

Of the four trials evaluating the effect of low-dose BT (100 units) on the NRS at 1 or 2 months, three showed positive results when compared with the control treatment; the fourth study failed to find any effect. The overall weighted mean difference was -0.95 (-0.02 to -1.88; p=0.05; I2=67 percent).

Data from the two trials evaluating the effect of high-dose BT (200 units) indicated that the agent had an almost zero effect on the NRS at 1 or 2 months, with an overall weighted mean difference of 0.13 (-0.55 to 0.81; p=0.71; I2=0 percent).

Data from the three trials evaluating NRS at 6 months reported an overall weighted mean difference of -0.57 (-1.98 to 0.83; p=0.42; I2=73 percent).

Researchers attributed the efficacy of BT-A in reducing pain in painful joint diseases to the ability of BT-A to block the release of neuropeptides, such as substance P and calcitonin gene-related peptide, which are key mediators of neurogenic inflammation and pain. This particular effect of the agent has been demonstrated in previous studies. [Pain 2013;154:2547–53; Chin J Plast Surg 2009;25:50–3; BJU Int 2008;101:366–70; J Urol 2006;175:1138–42]

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Most Read Articles
01 Sep 2016
Digoxin, as a new or preexisting therapy, does not increase mortality following acute phase of ST-elevation myocardial infarction (STEMI), as shown in the MAGIC study.
15 Apr 2016
Addition of digoxin to an ACE inhibitor lessens heart failure (HF) hospitalisation in HF patients with reduced ejection fraction, regardless of diabetes status, as presented in an analysis of the Digitalis Investigation Group trial.
22 Mar 2017
Patients often seek consultation at the pharmacy for superficial skin infection. The goal of this activity is to improve pharmacists' knowledge on strategies to manage bacterial skin infection.
 
Please click here to access this module
01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute.